Preoperative Assessment Lecture Notes PDF

Made with Xodo PDF Reader and Editor Ministry of Higher Education and Scientific Research College of Health and Medical Technology Anaesthesia Techniques Department Teaching package for anaesthesia techniques 3rd stage. 2023-2024  Made...

Made with Xodo PDF Reader and Editor Ministry of Higher Education and Scientific Research College of Health and Medical Technology Anaesthesia Techniques Department Teaching package for anaesthesia techniques 3rd stage. 2023-2024  Made with Xodo PDF Reader and Editor Preoperative assessment The pre-operative assessment is an opportunity to identify co-morbidities that may lead to patient complications due to anesthesia or surgical procedure, during the operative or post-operative periods. Patients scheduled for elective procedures will generally attend a pre-operative assessment 2-4 weeks before the date of their surgery. Premedication is using of medications in order to prepare the patient for anesthesia and to help provide optimal conditions for surgery. Specific needs will depend on the individual patient and procedure. Goals of preoperative assessment: 1) Doctor-patient relationship 2) Plan of Anesthetic Technique 3) Screen for and manage co-morbid disease. 4) To assess and minimize risks of anesthesia. 5) To identify need for specialized techniques. 6) To identify need for advanced post-op care. 7) Preoperative Preparation. 8) Perioperative risk determination. 9) Reduce patient anxiety. 10) To obtain informed consent.  Made with Xodo PDF Reader and Editor Minimum preoperative visit components (according to ASA): 1) Medical, anesthesia and medication history. 2) Appropriate physical examination. 3) Review of diagnostic data (ECG, labs, x-rays). 4) Assessment of ASA physical status. 5) Formulation and discussion of anesthesia plan. Note// ASA = American Society for Anesthesiologists. The ASA physical classification: ASA1: normal healthy patient. ASA2: Mild systemic disease - no impact on daily life. ASA3: Severe systemic disease - significant impact on daily life. ASA4: Severe systemic disease that is a constant threat to life. ASA5: Moribund, not expected to survive without the operation. ASA6: Declared brain-dead patient - organ donor. E: Emergency surgery.  Made with Xodo PDF Reader and Editor History 1) Medical problems (current & past). DM, HTN,COPD,CAD,thyroid disorder.. Regular medications Previous surgeries; date: 5.Family anesthesia history: Problems with anesthesia in family type of anesthesia: (Pseudocholinesterase deficiency and malignant hyperpyrexia) 2) Previous anesthesia & related problems. Allergy to drugs PONV  Made with Xodo PDF Reader and Editor Anesthesia awareness Difficult intubation Delayed emergence 3) Allergies and drug intolerances. 4) Medications, alcohol & tobacco. 5) Review of systems (include snoring and fatigue). 6) Exercise tolerance and physical activity level. Physical examination 1) Airway. 2) Heart and lungs. 3) Vital signs including O2 saturation ( Blood pressure, Resting pulse, rate, rhythm, Respiration, rate, depth, and pattern at rest, Body temperature 4) Height and weight (BMI). 5) Other Specific examinations depending on the individual patient and procedure. Airway Assessment Predictors of difficult intubation Mallampati classification ULBT (upper lip bite test) Inter-incisors gap (IID) Thyromental distance (TMD) Forward movement of mandible Document loose or chipped teeth Tracheal deviation Movement of the Neck  Made with Xodo PDF Reader and Editor Modified Mallampati score: Used to predict the ease of endotracheal intubation, the score is assessed by asking the patient, in a sitting posture, to open his or her mouth and to protrude the tongue as much as possible. Class I: Soft palate, uvula, fauces, pillars visible. Class II: Soft palate, major part of uvula, fauces visible. Class III: Soft palate, base of uvula visible. Class IV: Only hard palate visible. A high Mallampati score (class 3 or 4) is associated with more difficult intubation as well as a higher incidence of sleep apnea. Thyromental distance (TMD) Distance from the thyroid cartilage to the mental prominence when the neck is extended fully. Should be 7 cm  Made with Xodo PDF Reader and Editor Sternomental distance (SMD) Distance from the upper border of the manubrium sterni to the tip of the chin, with the mouth closed and the head fully extended. Should be > 12.5cm  Made with Xodo PDF Reader and Editor Laryngoscopy: Cormack and Lehane Also Look for: Body: obese? If female: large pendulous breast? Neck anatomy: short? thick? webbed? Mouth: limitations (opening)? Teeth? (number & health) Enlarged tongue? (hypothyroidism, acromegaly & obesity) Mandible (+TMJ): micrognathia,receding mandible (ask patient to sublux their lower incisor beyond upper incisor) Maxilla: protruding? (buck teeth) | Face: beard? Facial trauma? | Nose: nasal passage patency, Head size: Children (ex. hydrocephalus or rickets) | Adults (ex. acromegaly)  Made with Xodo PDF Reader and Editor Cardiovascular system: Dysrhythmias Atrial fibrillation Heart failure Heart murmur Valvular heart disease Blood pressure is best measured at the end of the examination Respiratory system cyanosis pattern of ventilation respiratory rate RR Dyspnoea Wheeziness signs of collapse consolidation and effusion Pulmonary disease Smoking Increased carboxyhemoglobin levels. Decrease ciliary function. Increase sputum production. Nicotine adverse effects on cardiovascular system. Preoperative advices: 2 days cessation can decreases nicotinic effect, improve mucus clearance and decrease carboxyhemoglobin levels 4-8 weeks of cessation are believed to be needed for postoperative complication reduction Asthma Obtain information about irritating factors, severity and current disease status. Frequents use of bronchodilators, recurrent hospitalization and requirements for systemic steroids are all indicators of severe disease. Those who received more than a (burst and taper) of steroids in the previous 6 months should be considered for stress dose perioperatively.  Made with Xodo PDF Reader and Editor Respiratory Tract Infection Patients presenting on the day of surgery with symptoms and signs of a lower respiratory tract infection should be treated appropriately and postponed to such time that they are symptom free. Viral upper respiratory tract infection can cause bronchial reactivity which may persist for 3-4 weeks. Unless surgery is urgent, such patients should be postponed for 4 weeks to minimize the risk of postoperative respiratory infection  Made with Xodo PDF Reader and Editor Prolonged fasting should be avoided as this is associated with dehydration, increased postoperative nausea and vomiting, electrolyte imbalance and patient distress. Optimal fasting hours decreases volume and acidity of stomach contents and reduce aspiration and regurgitation risk